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KROK 2 Medicine 2021 Questions | KROKEXAM
Browse 2021 KROK 2 Medicine exam questions with answers and explanations.
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A 2-month-old boy was born with body weight of 5100 g. The baby has jaundice, hoarse cry, umbilical hernia, and a delay in physical development. The liver is +2 cm, the spleen is not enlarged. The umbilical cord separation was delayed in the baby. In the blood: Hb – 120 g/L, erythrocytes – 4.5 · 1012/L, ESR – 3 mm/hour. Total serum bilirubin – 28 mcmol/L, indirect bilirubin – 20 mcmol/L, direct bilirubin – 8 mcmol/L. What disease is suspected first?
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A 31-year-old woman has complains of pain and swelling in her radiocarpal and metacarpophalangeal joints and morning stiffness for up to 1.5 hours. These signs have been observed for the last 3 years. Two weeks ago she developed pain, swelling, and redness in her knee joints and fever of 37.5°C. The examination of her internal organs shows no pathological changes. She was diagnosed with rheumatoid arthritis. What changes will most likely be visible on the X-ray scan of her joints?
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A 7-year-old boy suddenly developed pain and edema in the right knee. The day before, at school, he took part in cross-country skiing. There is no family history of hemophilia or susceptibility to bleeding. His body temperature is 37.5°C. The knee is painful on palpation, hot to the touch, and has edema with local tissue tension above it. In the blood: Hb – 123 g/L, leukocytes – 5.6 · 109/L, platelets – 354 · 109/L, prothrombin time – 12 seconds (normal range is 10–15 seconds), activated partial thromboplastin time – 72 seconds (normal range is 35–45 seconds). Bleeding time is normal, the factor VIII levels constitute 5% of normal value. Make the right diagnosis:
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A 13-year-old girl came to a school doctor. Two days ago she first developed moderate bloody discharge from her genital tracts. Her secondary sexual characteristics are developed. What is most likely the cause of the bloody discharge in this case?
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For 2 hours after giving birth, the condition of the mother remains stable. Her uterus is dense and spherical, its floor is at the level of the navel, there is no bleeding. The clamp applied to the umbilical cord remains at the same level. When the woman is taking a deep breath and the edge of the palm is pressed over her symphysis, the umbilical cord retracts into the vagina. There is no bloody discharge from the genital tracts. What are the doctor’s next tactics?
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A 28-year-old man had an acute onset of the disease. He began feeling too hot and developed chills, fever of 38.5°C, tenesmus, paroxysmal pain in his left iliac region, and frequent liquid stools with blood and mucus. Abdominal palpation is painful on the left, the sigmoid colon is spastic. Make the right diagnosis:
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A 54-year-old man was hospitalized with complaints of a sudden severe headache in the back of the head and vomiting. He has a history of moderate hypertension and takes hypothiazide. Three days ago he came to a therapist, complaining of an intense headache, which was relieved with an analgesic. His consciousness is clouded and his left pupil is dilated. He presents with marked photophobia, tense neck muscles, and leftsided hemiparesis with increased muscle tone and reflexes. His temperature is low. No rash is observed in the patient. His blood pressure is 230/130 mm Hg, pulse – 50/min., respiratory rate – 12/min. Make the right diagnosis:
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A 25-year-old woman at 34 weeks of pregnancy was hospitalized in a critical condition into the maternity clinic. She has complains of headache, vision impairment, and nausea. She has edemas, her blood pressure is 170/130 mm Hg. Suddenly, the woman developed fibrillar twitching of her facial muscles, tonic and clonic seizures, and respiratory arrest. One and a half minutes later her breathing resumed and blood-tinged foam appeared from her mouth. Her urinary protein levels are 3.5 g/L. Make the right diagnosis:
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During the study of pulmonary tuberculosis morbidity, the data on socioeconomic living conditions and harmful habits of the patients were obtained. What methods allow the assessment of the extent to which these factors influence the tuberculosis morbidity?
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A 2-month-old girl was being transferred to formula feeding. She was born with the body weight of 3500 g. Now, her body weight is 3900 g. What is the normal daily volume of feeding for this baby?
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A 33-year-old man was hospitalized with a recurrent ulcer bleeding that was stopped. During the examination he is exhausted and pale. Blood test shows Hb of 77 g/L and Ht that equals 0.25. Due to anemia, there were two attempts to transfuse him with the blood of his group – A(II) Rh(+). Both transfusions must be stopped because of anaphylactic reaction development. What transfusion medium is indicated in this case?
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A 74-year-old woman complains of painful and distended abdomen and nausea. She suffers from postinfarction and atherosclerotic cardiosclerosis and ischemic heart disease. She is in a severe condition, her abdomen is distended, the abdominal wall is barely involved in the act of breathing. Laparoscopy detected a small amount of turbid exudate in the abdominal cavity, one of the small intestine loops is dark blue. Make the right diagnosis:
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It was determined that in a group of 100 births, given women with risk factors, there were 30 premature births, while among the 100 births, given by women without risk factors, there were 5 premature births. What method of statistical data processing is optimal, if a physician needs to assess the validity of such differences in compared groups?
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For the last 3 days a 2-year-old girl has been presenting with fever of 38.0°C, runny nose, dry cough, inertness, and appetite loss. Percussion sound has a bandbox resonance. Auscultation detects puerile breathing without wheezing. In the blood there are leukopenia, lymphocytosis, and accelerated ESR. Make the right diagnosis:
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A 25-year-old man has complains of weakness, progressive shortness of breath, and leg edemas. Previously, he was healthy, but recently he has been taking ibuprofen for his sprained ankle ligaments. His pulse is 90/min., blood pressure is 180/100 mm Hg. The heart sounds are sonorous. In the lungs, the percussion sound is dull in the lower right segment. The liver is +3 cm. In the blood: Hb – 103 g/L, leukocytes – 6.7·109/L, platelets – 236·109/L, urea – 24.6 mmol/L, creatinine – 0.254 mcmol/L, Na+ – 135 mmol/L, K+ – 5.6 mmol/L, albumin – 27 g/L. Chest X-ray has shown rightsided pleurisy, the heart is normal. What pathological condition is observed in the patient?
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A mother of a 5-year-old girl has complains of nocturnal incontinence in her child, night terrors, disturbed sleep, and low weight gain. The girl is undereating, intellectually well developed, can read, explains life situations as an adult. Her skin is pale, the liver is enlarged. The mother suffers from cholelithiasis. What type of diathesis is most likely the child has?
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A 42-year-old woman is suffering from micronodular cryptogenic cirrhosis of the liver. During the last week, her condition has been deteriorating she developed seizures and clouded consciousness, her jaundice intensified. What test can help find the cause of deterioration in this patient’s condition?
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On the 4th day after a surgery for a cystoma in the right ovary, a woman suddenly developed a fever of 37.7°C and a chest pain on the right with expectoration of pink sputum. Examination of the lungs has revealed a dull pulmonary sound and isolated wet crackles in the lower right segments. What complication is most likely developed in this patient?
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Throughout the last year a 27-yearold man notes fatigue, excessive sweating, and heaviness in his left subcostal region, especially after eating. His spleen and liver are enlarged. Blood test: erythrocytes – 3.2 · 1012/L, Hb – 100 g/L, color index – 0.87, leukocytes – 100 · 109/L, basophils – 7%, eosinophils – 5%, monocytes – 15%, juvenile – 16%, band neutrophils – 10%, segmented neutrophils – 45%, lymphocytes – 2%, monocytes – 0%, reticulocytes – 0.3%, platelets – 400 · 109/L, ESR – 25 mm/hour. Make the right diagnosis:
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A 66-year-old man has complains of marked weakness. The onset of the disease was acute: he developed fever and pain in the joints and along the muscles of his legs. He has a violet-cyanotic erythema around his eyes and over the knee joints. His heart rate is 120/min., heart sounds are weakened. Blood test: leukocytes – 12 · 109/L, ESR – 40 mm/hour. Make the right diagnosis:
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A 22-year-old young woman has complains of an aching pain in her right iliac region throughout the last week, morning sickness, and taste distortions. Her menstruation is delayed for 3 weeks already. Her blood pressure is 110/70 mm Hg, pulse – 78/min., t° – 37.0°C. Bimanual examination shows that her uterus is slightly enlarged, soft, mobile, and painless. Palpation of the uterine appendages detects on the right a painful and moderately mobile dense-elastic formation 3x4 cm in size. Make the right diagnosis:
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For the past 6 years a 37-year-old woman has been experiencing frequent nosebleeds, severe metrorrhagias, and periodic bruising on her skin. 12 days ago, after a severe nosebleed, her weakness intensified, she developed dizziness and palpitations. Her skin is pale, there are multiple petechiae and isolated ecchymoses on the anterior surface of her torso, legs, and arms. In the blood: Hb – 80 g/L, erythrocytes – 4.0 · 1012/L, color index – 0.7; leukocytes – 5.3 · 109/L; band neutrophils – 2%, segmented neutrophils – 65%, eosinophils – 2%, lymphocytes – 24%, monocytes – 5%, platelets – 10 · 109/L, ESR – 15 mm/hour. Make the right diagnosis:
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A patient in a state of clinical death receives closed-chest cardiac massage and mouth-to-mouth artificial pulmonary ventilation. The doctor noticed that the air does not enter the patient’s airways, and his head and torso are at the same level. Why is the artificial pulmonary ventilation ineffective in this case?
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A 54-year-old patient, a heavy drinker, who 4 years ago had a case of viral hepatitis B, has been experiencing heartburn and a burning pain retrosternal for the past two months. In the morning, after eating and lifting a heavy object, he had an episode of vomiting with fresh dark blood. His skin is pale and moist, pulse – 92/min., blood pressure – 90/60 mm Hg. His sclerae are icteric. His abdomen is enlarged due to ascites and hepatosplenomegaly. What is the most likely cause of bleeding in this case?
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A 63-year-old woman has undergone a surgery for a large multinodular euthyroid goiter. Subtotal resection of the both lobes of the thyroid gland had to be performed, which was done with technical difficulties. On the 4th day after the surgery, the woman developed abdominal pain and muscle spasms in her face and arms. The Chvostek and Trousseau signs were positive. What is the most likely the cause of the patient’s condition?
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A 3-year-old child has a cough and runny nose. Two other family members have the same signs. On the third day after the onset of the disease, the cough intensified and became dry and persistent. The temperature increased to 37.8°C. The act of breathing involves the auxiliary muscles. Percussion produces a banbox resonance bilaterally in the lungs. Breathing is harsh, expiration is prolonged, there are moderate and large bubbling wheezes. The wheezes are diffuse and mostly wet, though in some places they are dry. Make the right diagnosis:
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A 35-year-old man has complains of a chest pain that persists for several months already and an occasionally observed bitter taste in his mouth. The pain is localized behind the sternum, occurs at rest, and sometimes irradiates into the neck. It doesn’t intensify during physical exertion, but may intensify after drinking alcohol or eating a large meal. At night, this condition becomes worse. Swallowing is not disturbed. The body weight is increased. Examination detected no changes. Make the right diagnosis:
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A 35-year-old patient for the last 3 years is on hemodialysis due to chronic glomerulonephritis. He developed cardiac irregularities, hypotension, progressing weakness, and dyspnea. ECG has shown bradycardia, first-degree atrioventricular block, and tall and sharp T waves. The day before, he had a gross violation of drinking and dietary regimes. What biochemical changes are most likely the cause of the described clinical presentation?
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At the oligoanuric stage of acute renal failure, a 10-year-old child has developed a tingling sensation in the tongue and oral mucosa, numbness of the limbs, decreased reflexes, respiratory disorders, and arrhythmia. What are the causes of these signs?
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A child with chronic carditis, heart failure class IIA, who was being treated with digoxin, developed increasing bradycardia, nausea, vomiting, dizziness, and disturbed sleep. ECG has shown an extrasystole, PQ is 0.18. What is most likely the cause of this condition?
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The human body receives several chemicals from the atmosphere. How is called the type of combined action. in which the combined effect is less than the sum of the effects of each of substances present in combination during their isolated action on the body?
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A woman suffers from bronchial asthma with concomitant type 1 diabetes mellitus, receives in complex therapy: salmeterol, beclomethasone, euphylline, cromolyn and prednisolone. After appointment of which of the following groups of drugs requires insulin dose adjustment?
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An employee of a paint factory complains of an unpleasant taste in the mouth, cramping abdominal pain, constipation, which are not removed by laxatives. Objectively established: the skin of the face is pale grayish, on the edge of the gums near front teeth - a strip of grayish-purple color. During the laboratory study found: anemia in the blood, reticulocytosis, basophilic granularity of erythrocytes, increasedbilirubin content; in the urine - an increased content of porphyrin. What is the disease of the worker?
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A 45-year-old man went to the doctor with complaints of irritability, fatigue, weight loss, palpitations, heart failure. During palpation of the left thyroid lobe the gland is palpated the formation of a dense-elastic consistency, painless, which during swallowing is displaced together with the thyroid gland. Positive eye symptoms, exophthalmos, convergence disorders. Blood pressure - 135/80 mm Hg. Art., pulse - 110/min. During the ultrasound examination of the thyroid gland in the left lobe is visualized hyperechogenic round formation measuring 2 × 3 cm, with clear contours, homogeneous structures. Which conclusion of the doctor after the examination will be the most correct?
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The man complains of purulent discharge from the penis in the morning before urination, urination, pollakiuria. Pyuria was detected during a three-glass test in the first portion of urine. What is the probable diagnosis?
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The mother of a 3-year-old boy found a tumor-like formation in the abdomen while bathing the child. During the examination, a dense, painless, flat surface, sedentary is determined tumor-like formation of large size, located under the left costal arch. Body temperature - 37.5°C, heart rate - 110/min., AT - 150/90 mm Hg. Art. In the general analysis of blood detected: erythrocytes - C, 2 × 1012/ l, Hb - 90 g/l, leukocytes - 10.4 × 10 ^ g/l, ESR - 35 mm/h. In the general analysis of urine it is revealed: erythrocytes on all field of view. What disease is possible to suspect a child?
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A boy of 8 years, went to the doctor with complaints of fatigue, decreased appetite, icteric sclera, abdominal pain. The neonatal period was prolonged jaundice. In physical development does not lag behind. Objectively established: pale skin, mucous membranes shells and sclera icteric. Liver - +2 cm, slightly painful on palpation. Defecation and urination are normal. During a laboratory blood test found: erythrocytes - 4,5 × 1012/l, hemoglobin - 115 g/l, leukocytes - 7 × 10 ^ g/l, speed erythrocyte sedimentation rate - 8 mm/h, direct bilirubin - 10 μmol/l, indirect - 39 μmol/l, aspartate aminotransferase (AST) - 17 u/l, alanine aminotransferase (ALT) - 21 U / l. Which is the diagnosis most likely?
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Woman 37 years old, chemist-technologist. Worried about the appearance of bruises on the abdomen, thighs, legs after minor injuries or without cause. During the examination, numerous bruises were found, which in places merge (from 1 × 1 to 4 × 5 cm). There are no other changes. Menstruation lasts up to 7 days. Spleen not palpable. In the blood found: Hb - 92 g/l, leukocytes - 7.2 × 109/l, platelets - 6 × 10 ^ g/l, erythrocyte sedimentation rate - 33 mm/h. What is the pathogenesis of this disease?
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A 38-year-old patient went to a women's clinic with complaints of moderate bleeding discharge from the genital tract, which occurred after the delay of the next menstruation for 1.5 months. During the vaginal examination revealed: the cervix is not eroded, the symptom of "pupil" (+++); the uterus is not enlarged, dense, mobile, painless; appendages on both sides are not enlarged, painless; the vaults are deep. Which diagnosis is most likely?
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A 52-year-old man who consulted a gastroenterologist for a stomach ulcer, dysplastic obesity, stretch marks on the abdomen and thighs were detected. Blood pressure - 170/100 mm Hg Art. During the laboratory examination revealed elevated levels of cortisol, moderately low ACTH levels. What is the probable diagnosis?
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